Using Behaviour Change Technique (BCT) analysis to improve fidelity to treatment manuals in smoking cessation: A case study Billie Bonevski, Laura Twyman,

Using Behaviour Change Technique (BCT) analysis to improve fidelity to treatment manuals in smoking cessation: A case

study

Billie Bonevski, Laura Twyman, Fabiana Lorencatto, Susan Michie & Robert West

Newcastle, Australia 2

The Trial

• The primary aim is to evaluate the efficacy of a community social service case-worker delivered smoking cessation intervention for socially disadvantaged smokers

• The study design is a randomised controlled trial

• The primary outcome measure is CO verified continuous abstinence at 6 months follow-up

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The Call it Quits smoker (n = 309) 4

The case-worker delivered intervention:Key components

• Delivered by trained volunteer case-workers

• Systematically (electronically) assessing and recording smoking status in client notes

• Tailored (based on print-out)

• Provision of advice to quit and behavioural counselling, motivational interviewing if required over two face-to-face sessions

• Free nicotine replacement therapy

• Buddy system

• Flexible follow-up through telephone calls, or drop-ins

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But what are our intervention participants really receiving?

The aims of the current study

1. Assess volunteer case-worker fidelity to the Call it Quits intervention manual using BCT analysis

2. Assess the effectiveness of BCT performance feedback in improving fidelity to intervention manual

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Methods

• Pre and post test study embedded in one intervention trial (Call it Quits)

• 6-week pre-test period of recording counselling sessions

• 6-week period post-intervention of recording counselling sessions

• Main outcome:

– Proportion of each manual specified BCT delivered pre and post

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Methods 8

Results: BCTs coded in the manual9

Tailor interaction appropriately Facilitate goal setting

Boost motivation and self efficacy Prompt review of set goals

Provide feedback on current behaviour and progress Advise on stop smoking medication

Provide rewards contingent on not smoking Advise on/facilitate the use of social support

Prompt commitment from the client there and then Ask about experience of stop smoking medication that the smoker is currently using

Provide rewards contingent on effort or progress Give options for additional and later support

Facilitate identification of reasons for wanting and not wanting to stop smoking

General communication approach

Explain the importance of abrupt cessation Facilitate relapse prevention and coping

Conduct motivational interviewing Promote cut-down-quit

Facilitate barrier identification and problem solving Advise on management of mental health problems

Information gathering and assessment Assess alcohol or drug use disorder

Facilitate action planning/develop a treatment plan Arrange follow-up session

Pre-test Results - Volunteer case-worker session recordings (n=23)

Individual Volunteer

B A P I G S K Total

1st F2F 1 5 1 2 9

2nd F2F 2 3 5

1st t/c 1 1 2

2nd t/c 2 1 3

Final t/c 1 1 1 1 4

Total 2 2 3 7 1 5 3

Duration (mins)

2.1-3.4

2.5-33.2

3.4-7.6

4-25.6

7.5 3-12.5

3.1-46.4 2.5 - 46.4

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Inter-rater reliability

• 50% of pre-test coding

• Between two coders (BB & LT)

• Assessed using percentage agreement

• 79% (High - > 75%)

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Pre-test Results - Number of face to face sessions each BCT delivered in (out of possible 14) 12

BCT label N (%) N (%)

Tailor interaction appropriately 8 (57) Facilitate goal setting 9 (64)

Boost motivation and self efficacy 3 (21) Prompt review of set goals 0

Provide feedback on current behaviour and progress

10 (71) Advise on stop smoking medication 14 (100)

Provide rewards contingent on not smoking 0 Advise on/facilitate the use of social support 13 (93)

Prompt commitment from the client there and then

9 (64) Ask about experience of stop smoking medication that the smoker is currently using

12 (86)

Provide rewards contingent on effort or progress 6 (43) Give options for additional and later support 3 (21)

Facilitate identification of reasons for wanting and not wanting to stop smoking

5 (36) General communication approach 14 (100)

Explain the importance of abrupt cessation 6 (43) Facilitate relapse prevention and coping 5 (36)

Conduct motivational interviewing 3 (21) Promote cut-down-quit 12 (86)

Facilitate barrier identification and problem solving

6 (43) Advise on management of mental health problems 1 (7)

Information gathering and assessment 13 (93) Assess alcohol or drug use disorder 10 (71)

Facilitate action planning/develop a treatment plan

14 (100) Arrange follow-up session 14 (100)

Pre-test Results - Number of telephone sessions each BCT delivered in (out of possible 9) 13

BCT label N (%) N (%)

Tailor interaction appropriately 3 (33) Facilitate goal setting 0

Boost motivation and self efficacy 8 (89) Prompt review of set goals 2 (22)

Provide feedback on current behaviour and progress

8 (89) Advise on stop smoking medication 2 (22)

Provide rewards contingent on not smoking 1 (11) Advise on/facilitate the use of social support 4 (44)

Prompt commitment from the client there and then 0 Ask about experience of stop smoking medication that the smoker is currently using

5 (56)

Provide rewards contingent on effort or progress 4 (44) Give options for additional and later support 8 (89)

Facilitate identification of reasons for wanting and not wanting to stop smoking

2 (22) General communication approach 7 (78)

Explain the importance of abrupt cessation 0 Facilitate relapse prevention and coping 2 (22)

Conduct motivational interviewing 0 Promote cut-down-quit 3 (33)

Facilitate barrier identification and problem solving 2 (22) Advise on management of mental health problems 3 (33)

Information gathering and assessment 2 (22) Assess alcohol or drug use disorder 3 (33)

Facilitate action planning/develop a treatment plan 0 Arrange follow-up session 5 (56)

BCT Performance feedback intervention 14

Group feedback session outlining:

– Number of recordings per volunteer

– BCTs specified in manual

– BCTs delivered by each volunteer (anonymous)

– Positive reinforcement

– Discussion of BCTs, identification of aids to help boost BCT use

Individual performance feedback letters including:

– Length of sessions (in minutes)

– List of BCTs identified and positive reinforcement

– List of BCTs not coded

– Goal setting – increase unused BCTs in 6 months

BCT Performance feedback intervention

• Desktop checklist with ‘top 5’ BCTs – goal for improvement

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In face-to-face sessions

1. Explain the importance of abrupt cessation

2. Prompt commitment from the client there and then

3. Facilitate action planning/develop a treatment plan

4. Facilitate goal setting

5. Advise on stop smoking medication

In telephone follow-up calls

1. Prompt review of set goals

2. Provide feedback on current behaviour and progress

3. Boost motivation and self-efficacy

4. Facilitate relapse prevention and coping

5. Provide rewards contingent on effort or progress

Next steps

• Continue coding post-test sessions

• Compare pre and post test use of manual specified BCTs

• Assess by

– session type (face to face, telephone follow-up)

– duration,

– volunteer

– BCT

• Assess inter-rater reliability for new BCTs

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CRICOS Provider 00109J | www.newcastle.edu.au

THANK YOU

Funding:•National Health & Medical Research Council•Cancer Institute NSW•Hunter Medical Research Institute

•Anglicare Community Care Centre Wollongong clients, volunteers and staff

Contact me on:[email protected] ph: +61 02 40335710

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